Painful Sex Still a Painful Secret

In fact, the symptom of painful sex can be caused by muscle spasms; a skin condition called lichensclerosus or lichenplanus; or even an unexplained inflammation that leaves a woman's vulva with 10 times the number of nerve endings than usual.

Other doctors blame a lack of scientific study, not just the name.

"We have this term called vulvodynia, and people think is some great mysterious problem, but I don't think it is," said Stewart. "It's just like chest pain or foot pain or any other pain. We just need to study it to see all the things that can happen to it."

Whatever the medical profession calls it, women find it hard to find treatment even with a diagnosis of vulvodynia.

Misdiagnosis and Mistreatment

Pam P., 53, had no problem with painful sex until her first child was born.

"Within that next month after having childbirth, I found sex to be very, very painful," said Pam. When she returned to her obstetrician to see what went wrong, she thought it was a physical problem.

"I said I think either you sewed me up too tight on the episiotomy, or my husband grew — and I don't think that happened," she said.

Her doctor noticed her vaginal muscles had become very tight. Beyond that, however, Pam was told she should either "talk to a sex therapist" or "try lubrication."

For the next 15 years Pam mentioned her excruciating pain, and each time heard, "I can refer you to a sex therapist," or "Sorry, they don't have anything for women like Viagra yet."

Finally, she found an obstetrician who diagnosed her with a pelvic floor disorder often called vaginismus — a condition where the vaginal muscles involuntarily contract, making any penetration painful or next to impossible.

The involuntary reaction can be due to mental trauma, but more frequently it occurs because the cervix was tender, or a woman was not ready to have intercourse.

"If the muscles are tight enough, it can feel like hitting a brick wall," said Stewart.

Finding Help

With skin conditions, muscle spasms, nerve endings and a host of other causes, it can be difficult for a woman to find the correct expert to treat painful sex.

But a major problem, even gynecologists admit, is that doctors are not well trained to refer patients.

Out of 20,000 hours of training and residence, "I had one 45-minute-long lecture on all sexual dysfunction — sexual pain, libido, the whole shebang," said Goldstein. "Looking back, everything was wrong."

Yet when women find help in the right places, the results can change much more than sex lives.

Melissa B. suffered from painful sex from her first sexual experience in 1997. She wasn't abused, but she grew up in a puritanical, extremely religious home.

In 2005, after being told to remain abstinent by one gynecologist and failing to cure her problem with a sex therapist, Melissa found a physical therapist to help.

Cynthia, Pam and Melissa all found some success treating their sexual pain by visiting Raquel Perlis, a physical therapist based in Wellesley, Mass. The need for this therapy is so great, Perlis has a three month backlog of patients and treats 10 women a day for painful sex.

Perlis teaches women and their partners how to stretch and massage pelvic floor muscles. She also uses biofeedback, which visually displays the degree of muscle contractions on a computer screen. Overtime, women can visually learn to control and relax their pelvic floor muscles.

Melissa says the therapy gave her a sense of personal control and self-esteem.

"When you sit there in the waiting room and you see women who look normal, you don't feel like such a loser," said Melissa. "It's not the woman with the big ugly glasses or something silly like that, it could be anybody."

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